Provider Demographics
NPI:1437569738
Name:KALI FORTUNA LLC
Entity Type:Organization
Organization Name:KALI FORTUNA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KALI
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTUNA
Authorized Official - Suffix:
Authorized Official - Credentials:LADC, MS, NCC
Authorized Official - Phone:203-257-2654
Mailing Address - Street 1:3241 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4850
Mailing Address - Country:US
Mailing Address - Phone:203-257-2654
Mailing Address - Fax:203-283-9372
Practice Address - Street 1:3241 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4850
Practice Address - Country:US
Practice Address - Phone:203-257-2654
Practice Address - Fax:203-283-9372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1083251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health